Member States while seeking greater equity in health through solidarity and health for all.

EXECUTIVE DIRECTION 1.1 EXECUTIVE MANAGEMENT (EXM) Leading the Pan American Sanitary Bureau to provide relevant, efficient, and creative technical cooperation in health in support of Member States. Includes legal counsel and internal audit. ISSUES AND CHALLENGES > Evolving health profiles in the Americas with changing burdens of disease, persistent or increasing inequities, and the challenge of new and emerging disease patterns. > Increasingly complex political, economic, and social environments, with many actors in health, both nationally and regionally. > Ensure effective and creative implementation of the Strategic Plan 2003-2007 to address priority needs of Member States while seeking greater equity in health through solidarity and health for all. > Provide optimal support for the work of the Bureau through sound management, based on adequate information and knowledge and with improved efficiency. > Provide legal services and advice to all elements of the Organization, while protecting the Organization and facilitating its work in a complex international environment. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Health of all peoples of the Americas would be improved in the most equitable manner possible and in the context of global initiatives. AREA OF WORK OBJECTIVE(S) Lead, inspire, and direct all staff and offices of PAHO to work as one team with one goal, in order to respond to the national priorities and to the mandates of the Governing Bodies of PAHO and WHO. STRATEGIC APPROACH > Implement the Strategic Plan 2003-2007 and other mandates of the Governing Bodies, while addressing the Millennium Development Goals and other major global and regional initiatives. > Provide leadership and direction for all staff in all offices to insure integrity, excellence, efficiency, and the highest level of performance. > Ensure that the technical cooperation of PAHO serves the needs and interests of the Member States and is provided in an integrated and coherent manner. > Ensure sound financial management and adherence to all rules and regulations of the Organization. > Protect the legal status and interests of PAHO within both the Inter-American and United Nations systems. > Establish and operate the full administrative program for PAHO and the Regional Office of WHO, producing maximum economy and efficiency in Headquarters and all Field Offices and Centers. Proposed Program Budget 2004-2005 15

1.1 Executive Management (EXM) EXPECTED RESULTS 1. The Bureau s work complies with all mandates of the Governing Bodies. 2. Internal Audit and legal processes of PAHO remain sound. 3. Relations with Member States are managed successfully. 4. Available information better meets needs of internal and external clients. 5. Technical cooperation activities of the Bureau address Member States priorities in a coherent, integrated, and effective manner. 6. PAHO staff is aware of the direction of the Organization and satisfied with the support received from senior management. INDICATORS Governing Bodies record satisfaction with results of assessments of compliance with mandates. All recommendations of internal audits acted upon, All agreements signed on behalf of the organization executed in accordance with PAHO s policies, rules and regulations; and successful resolution of 90% of all cases involving the Organization before international or national tribunals. Senior government authorities express satisfaction with PAHO. Increased use of intranet and internet to share knowledge among stakeholders and greater satisfaction among internal and external users of information systems. More cross-organizational work in the development of the program budget. New concept of regional program operationalized in at least 3 topic areas. Staff complaints are resolved and few staff bring action against the Organization. Vision, mission and values drive the work of the Organization and current priorities of the Director known by staff. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 5,370,800 418,200 5,789,000 Total 2004-2005 5,206,300 418,200 5,624,500 Country - - - Percentage of estimated Intercountry - - - expenditure Regional 100% 100% 100% 16 Proposed Program Budget 2004-2005

EXECUTIVE DIRECTION 1.2 PROGRAM DEVELOPMENT AND MANAGEMENT (GPD) Coordinating and defining the corporate processes for planning, programming, monitoring, and evaluating technical cooperation with emphasis on results-based management. ISSUES AND CHALLENGES > It is important that the Secretariat addresses in its policies the constantly changing environment and the impact of macrodeterminants of health and development. These policies must also reflect and articulate with global mandates such as the WHO corporate strategy and the Millennium Development Goals. > PAHO s institutional development within the United Nations and Inter-American systems is a requisite for increasing the effectiveness of its cooperation with Member States. It must be complemented by the Organizational development thrusts identified in the Strategic Plan (SP) 2003-2007. > As 2004-2005 will be the first complete biennium within the SP period, it will be important to monitor progress towards the achievement of the objectives defined by the SP and Official Document 307. > Since this will also be the Secretariat s first biennium under a new administration, it will be important to monitor the transformation process in order to make any necessary realignments in a timely fashion. > The culture of and capacity for evaluation is limited, and PAHO s pioneering efforts in results-based management must now be enhanced by increasing the organizational learning from more in-depth evaluations. > Project management in countries and within the Secretariat is fragmented and varies in quality. It is also burdened by different monitoring and reporting approaches demanded by different donors. This is aggravated by the lack of effective, routine use of the AMPES/OMIS/FMIS system for project management. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Member States and external partners satisfied that the regional priorities are being effectively and efficiently addressed by PASB s technical cooperation. AREA OF WORK OBJECTIVE(S) Improved articulation of PAHO s policy-making and implementation and institutional development with relevant global and regional fora. STRATEGIC APPROACH > Promoting the institutional development of PAHO within the framework of the United Nations and Inter- American systems, through an increased understanding of this process by managers and staff. Proposed Program Budget 2004-2005 17

1.2 Program Development and Management (GDP) > Mainstreaming of PAHO s corporate policies related to poverty, gender, ethnicity, and globalization throughout the Organization and in its work with Member States. > Adapting to PAHO s context of best practices in policy and project planning, management, and evaluation. > Building capacity in countries as well as in the Secretariat for policy analysis and development and for project management. > Maximizing the intranet for capacity-building and for sharing experiences in the areas of policy analysis, planning, and evaluation. > Integrating all monitoring and reporting needs into the AMPES/OMIS/FMIS system. EXPECTED RESULTS 1. PAHO corporate policies developed taking into consideration the global directions. 2. PASB institutional development promoted and supported. 3. Programming, monitoring, and evaluation coordinated. INDICATORS Strategic analyses conducted in support of formulation of PAHO corporate policies. Select PAHO corporate policies developed in response to current or anticipated trends, mainstreamed at all levels and evaluated annually. Increased articulation of policy and planning with the global level and among Regions. Specific objectives and targets of PASB institutional development defined, and action research and/or interventions executed annually. Reports on institutional development submitted annually to managers. Annual process for BPB management and evaluation coordinated and relevant reports disseminated to the Executive Management and staff. Field and HQ staff trained to use AMPES process and instruments for more effective project management. Key reports disseminated by deadlines: 2004 and 2005 Annual Reports of the Director; BPB 2002-2003 evaluation report to EC and report on AMRO contribution to Global Expected Results in 2004. AMPES/OMIS modified to become more user friendly, to address WHO reporting needs and to facilitate the SP monitoring. BPB 2006-2007 proposal submitted to the Governing Bodies in 2005. PAHO participation in the global planning process, including the preparation of the GPW and the BPB 2006-2007, monitored and coordinated. 18 Proposed Program Budget 2004-2005

1.2 Program Development and Management (GDP) 4. Program-budget managed in a timely, informed manner. 5. Key elements provided for capacity building on project cycle management. 6. Support to countries and the Secretariat for project preparation. 7. EB project monitoring and evaluation in progress. 2004-2005 program-budgets managed within the authorized appropriation and allocation levels. Required budgetary information and reports submitted to Governing Bodies, Executive Management, and financial partners. Guidelines, manuals, and toolkits for development and management of the project cycle widely disseminated in countries and the Secretariat. Selected country and Secretariat staff trained on project development and management. Information System modules for registration, review, monitoring, and evaluation of EB projects designed, and installed, and staff trained in HQ and in the field. 80% of country and Secretariat requests for TC in project identification and design addressed. 80% of country requests for TC in investment projects, identification and planning addressed. All required projects reviewed through a streamlined multidisciplinary Project Review Process. Annual reports for selected EB projects each year submitted to Executive Management. Progress reports submitted to donors as scheduled for each project. Annual evaluation of selected EB projects according to respective agreements. 8. Capacity building in the area of evaluation. Evaluation tools and methodologies adapted and disseminated. Country and PASB staff trained to conduct or manage evaluations. Evaluation design and results shared by Intranet and Internet. 9. Evaluations conducted. Regional and country evaluation of TC programs, projects, themes, management, and effectiveness executed biennially. Preliminary results of the Strategic Plan midterm evaluation discussed with the Executive Management. Proposed Program Budget 2004-2005 19

1.2 Program Development and Management (GDP) RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 2,386,000 155,000 5,789,000 Total 2004-2005 2,332,400 155,000 2,487,400 Country - - - Percentage of estimated Intercountry 100% 100% 100% expenditure Regional - - - 20 Proposed Program Budget 2004-2005

EXECUTIVE DIRECTION 1.3 STAFF DEVELOPMENT (SDP) Fostering the development of a creative, competent, and committed workforce to maximize their potential in providing the highest level of technical cooperation to Member States. ISSUES AND CHALLENGES > Providing opportunities for staff to be updated in the competencies needed in a time of rapid change and turbulent external environment where the nature of technical cooperation and technology are continuously being redefined. > Enabling staff in different locations to adjust and adapt successfully to the new PAHO structure, new culture, and way of working in the Organization. > Staff work in a fast-paced environment and need to be supported to become part of a continuous learning community. > Continuously updating staff in the latest technology and tools so that they work more efficiently. > Successfully incorporating new staff into the Organization at a time when a high number of staff are retiring. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Productive, creative and committed workforce maximizes their potential and cooperates effectively with national and international partners in accomplishing the mission of the Organization. AREA OF WORK OBJECTIVE(S) Competencies of PAHO s workforce enhanced and advantage taken of full potential of individuals and teams. STRATEGIC APPROACH > Consistent and fair allocation of staff development resources. > Working collaboratively at all levels of the Organization in identifying and developing competencies needed to achieve the Strategic Plan. > Use a variety of learning methodologies to meet the needs of staff throughout the Region. > Application of best practices in learning methodologies and learning delivery. > Partner with WHO and other international organizations and agencies to provide optimum opportunities for learning and development in both agencies. > Ensure accessibility of information and learning opportunities via the Intranet. Proposed Program Budget 2004-2005 21

1.3 Staff Development (SDP) EXPECTED RESULTS 1. Staff development policies formulated and executed. INDICATORS Policies, including those of the rewards program, revised or formulated based on approved recommendations of workgroup. Rewards program executed annually. 2. Competencies enhanced. Staff at all levels of the Secretariat trained/coached in areas of competence pertinent to their work objectives and surveyed managers report improvements. 3. New staff oriented to function in PAHO s environment on a timely basis. 4. Collaboration and cooperation in work environment supported. Program of orientation revised, related information updated and managers briefed accordingly. 80% of new staff have advanced orientation within 2 years of recruitment. Teamwork in PASB defined and staff trained and supported to use teamwork modalities to achieve the project/unit objectives. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 1,583,300 2,400 1,585,700 Total 2004-2005 1,855,700 2,400 1,858,100 Country - - - Percentage of estimated Intercountry 100% 100% 100% expenditure Regional - - - 22 Proposed Program Budget 2004-2005

GOVERNANCE AND PARTNERSHIPS 2.1 EXTERNAL RELATIONS AND PARTNERSHIPS (ECO) Building and strengthening partnerships for health within the United Nations and Inter-American systems in the Region, with other multilateral, bilateral, and private organizations and funds, and with NGOs and other key stakeholders for attaining public health goals agreed to by the Member States. ISSUES AND CHALLENGES > Health is a priority goal in its own right as well as a central input into economic development and poverty reduction. In the last few years, health issues have taken center stage in the political development agenda, and this greater visibility has led to the establishment of special funds and initiatives designed to address the world's health problems (UNAIDS, GAVI, GFATM). > Summits of the Americas and the Ibero-American Summits present an important opportunity to highlight the health agenda in the Region and to heighten PAHO's profile through its participation. > Mandates issued by leaders at regional and international fora clearly have moved the health agenda forward, facilitated the work among countries, and shaped the activities of institutions such as PAHO. > PAHO needs to participate meaningfully in the interagency coordination for advancing the health-related Millennium Development Goals (MDGs) in relation to reduction of child mortality, maternal mortality ratios, and halting or reversing the spread of HIV/AIDS, malaria, and other diseases. > Need to increase resource mobilization for special groups and key countries in order to reduce inequities among and between countries and people. > Cooperating with evolving approaches of the international community to address social and economic development issues at the country level. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Health development issues and the regional and national health priorities are included in the global, hemispheric, and sub regional political agendas, and accordingly adequate resources mobilized nationally and internationally for the improvement of the health conditions in the Americas. AREA OF WORK OBJECTIVE(S) Partners sensitized to regional health priorities and the Organization's presence and influence in the international community strengthened. Proposed Program Budget 2004-2005 23

2.1 External Relations and Partnerships (ECO) STRATEGIC APPROACH > Positioning of the Organization in international health issues. > Anticipating international environment changes and suggesting organizational response. > Strengthening PAHO alliances and partnerships with other international organizations. > Promoting regional priorities and PAHO policies with the international community, making every effort to sustain current levels of support and, identifying other potential partners in this endeavor. > Providing information and communication for internal and external clients using Intranet and Internet. EXPECTED RESULTS 1. Relevant global and hemispheric processes, political agendas, and activities of sister organizations, have been influenced. 2. UN reform process and policy changes monitored. 3. Increased coordination with WHO, that facilitates better awareness of PAHO s special characteristics. 4. Articulation with foundations, the public, and CSO strengthened. 5. Alliances and partnerships with sister agencies, other international organizations, foundations, and private sector nurtured. INDICATORS Health included in agendas of Summits and participation of key health personnel from more countries in related subregional and regional meetings. Papers/ reports on external environment in relation to partnerships and resource mobilization updated and disseminated internally and to countries once a year. UN Reform policies analyzed and PAHO managers informed at least twice a year. PAHO experience with UN reform at country level monitored. Participation in all scheduled WHO regional joint meetings and in meetings of interested parties., Promotional events with different audiences organized. Official relations with requesting NGOs or CSOs working in health established in the biennium. Policy, operational, and administrative processes with NGOs revised and monitoring of relations increased. Joint declarations and plans are approved and executed. Events to promote health and support international development efforts are planned and celebrated jointly during the biennium. 6. Shared Agenda Initiative expanded. New areas of work, new partners included in the initiative, by the end of biennium. One joint seminar on a relevant health issue in the biennium. Shared Agenda process reflected at country level 24 Proposed Program Budget 2004-2005

2.1 External Relations and Partnerships (ECO) in at least three countries. 7. Efforts to support advancetowards the MDGs coordinated. PAHO participates in the interagency coordination to develop strategies and initiatives for the achievement of the health-related Millenium Development Goals. 8. Resource Mobilization Strategy monitored. Effectiveness of approaches to donors continually assessed in light of changing donor environment and to capitalize on new opportunities with nontraditional donors and HQ and countries informed regularly. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 1,667,100 884,400 2,551,500 Total 2004-2005 1,684,900 627,200 2,312,100 Country - - - Percentage of estimated Intercountry 100% 100% 100% expenditure Regional - - - Proposed Program Budget 2004-2005 25

GOVERNANCE AND PARTNERSHIPS 2.2 GOVERNING BODIES (GOB) Supporting the operations of Governing Bodies. ISSUES AND CHALLENGES > The policy making function by PAHO s Governing Bodies must reflect challenges and opportunities for regional health development within the framework of WHO mandates. > Documents submitted to PAHO Governing Bodies must contribute to the definition of a coherent set of mutually supportive corporate policies. > Logistical and operational support is required for the effective performance of PAHO s Governing Bodies. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL PAHO s Governing Bodies operation is effective and efficient AREA OF WORK OBJECTIVE(S) Technical and logistical support provided to PAHO s Governing Bodies. STRATEGIC APPROACH > Analyzing the issues considered and decisions taken by PAHO s Governing Bodies. > Maintaining and disseminating the database of GB documents, resolutions. > Coordinating the preparation of policy documents for submission to the GB. > Planning, organizing, implementing, and assessing the specific sessions of the GB. > Assisting GB elected officers in the performance of their functions. EXPECTED RESULTS 1. Improved policy content and relevance of documents for the Governing Bodies. 2. Logistical support effectively provided to meetings of the Governing Bodies. INDICATORS % of documents completed on time according to Rules of Procedure of the Government Bodies. On-time implementation of support services to the Governing Bodies meetings. Recommendations of evaluation made of each GB session in collaboration with participant 26 Proposed Program Budget 2004-2005

2.2 Governing Bodies (GOB) 3. Database of GB document, resolutions updated, and disseminated. delegations incorporated into planning for subsequent meetings. Quarterly updating of GB webpage. Ongoing updating of GB databases. RESOURCES (EUA$) Regular budget Other sources All funds Total 2002-2003 2,465,300 122,000 2,587,300 Total 2004-2005 2,465,300 122,000 2,587,300 Country - - - Percentage of estimated expenditure Intercountry - - - Regional 100% 100% 100% Proposed Program Budget 2004-2005 27

GOVERNANCE AND PARTNERSHIPS 2.3 PUBLIC INFORMATION (INF) Sharing key institutional and public information with stakeholders and the public at large to promote awareness and support for health. ISSUES AND CHALLENGES > PAHO must remain proactive, transparent, and quick to compete in the glutted information marketplace to ensure its message stands out, especially on the Internet. > Technical advisers need to be made aware of the value added by having communications strategies included in all programs and projects, as called for in the Strategic Plan. > A significant challenge is to use cutting edge technology and retain experienced staff within a competitive market, while trying to curtail costs. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL The work of the Organization is promoted to a wider range of publics, bringing greater recognition to the Regions public health policies and the Organization s policies, priorities and goals. AREA OF WORK OBJECTIVE(S) Communication strategies will be incorporated into technical cooperation programs and projects to enhance effectiveness and sustainability of technical cooperation. STRATEGIC APPROACH > All health messages and materials will invoke sensitivity to the need for equity and protection of the most vulnerable groups. > Produce high quality materials and disseminate them in different forms to different audiences. > Promote the integration of communication strategies in all phases of technical cooperation. > Promote organizational branding, in all materials including audio and visual products. 28 Proposed Program Budget 2004-2005

2.3 Public Information (INF) EXPECTED RESULTS 1. A wide range of products supports technical cooperation and target more audiences. 2. Increased outreach to promote the Organization and enhance partnerships. 3. Capacity for formulating and utilizing communication strategies increased. INDICATORS Campaigns designed and executed to promote annual program of international days and selected technical areas as requested. Video public service announcements produced with more partners and sent to at least 20 more stations than in the previous biennium. Distribution of the radio program Salud Siempre will be increased by 10%. Perspective magazine and PAHO Today Newsletter reach 10% more readers respectively, than in last biennium. The number of news releases and fact sheets produced increased by 10% and disseminated to 15% more journalists. The number and type of partnership with civil society increased and each year the speakers bureau reached more organizations/publics. At least 60% of all EB technical cooperation projects approved have communication components. Staff at all levels trained to develop communication strategies and to partner with media. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 2,689,700 429,500 3,119,200 Total 2004-2005 2,801,000 429,500 3,230,500 Country - - - Percentage of estimated Intercountry 100% 100% 100% expenditure Regional - - - Proposed Program Budget 2004-2005 29

2.4 Retirees Health Insurance (RHI) GOVERNANCE AND PARTNERSHIPS 2.4 RETIREES HEALTH INSURANCE (RHI) The Pan American Health Organization s share of the health insurance contribution ( Premium ) for PAHO/WHO staff that retire in the Region of the Americas. ISSUES AND CHALLENGES > The cost to the Organization for retirees health insurance is mandated by the United Nations system, and represents a real fixed cost to PAHO. > The escalating cost of health care world-wide contributes to the increasing cost of RHI and detracts from PAHO s already scarce financial resources needed for program activities. > The number of staff from other regions retiring in the Americas continues to be greater than the staff from AMRO who retire abroad. This net influx of retirees into the region of the Americas adds to PAHO s RHI costs. The cost of WHO staff retiring from other Regions to the Americas in 2003 is $525,000, or over $1 million per biennium, and represents approximately one-fifth of the total budget for RHI. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 4,700,000-4,700,000 Total 2004-2005 6,000,000-6,000,000 Country 43% - 43% Percentage of estimated Intercountry 43% - 43% expenditure Regional 14% - 14% 30 Proposed Program Budget 2004-2005

COUNTRY PROGRAM SUPPORT 3.1 EMERGENCY AND HUMANITARIAN ACTION (EHA) Support to countries in disaster preparedness and emergency relief, and in mitigating and reducing their vulnerability to natural and man-made disasters. ISSUES AND CHALLENGES > The Region of the Americas is prone to a range of natural disasters. In addition, bioterrorism is emerging as a priority. The economic and social cost of disasters is significant and the recovery phase can be prolonged, often delaying development goals. > The poorest segments of the population are disproportionately affected because of inappropriate location and construction of housing. A rapid multisectoral response capacity is needed to provide humanitarian assistance, prevent the spread of communicable diseases, and maintain the mental health of populations in stressful postdisaster environments. > In-country capacity has improved, especially at the technical level. However, there is still a long way to go before disaster reduction is institutionalized and adequately resourced. > Disaster mitigation remains even more of a challenge, as countries do not see benefits unless a disaster has just occurred. Mitigation needs to focus on water utilities as well as health infrastructure and services. It has to be part of the development process. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Vulnerability and impact of disasters on health and on health-related systems reduced. AREA OF WORK OBJECTIVE(S) Countries demonstrate increased national and intersectoral capacity for preparedness for natural and manmade disasters and are able to assess their post-disaster health needs and efficiently manage the aftermath of disasters. STRATEGIC APPROACH > Policy support to enhance mitigation, including sensitization of policy-makers. > Cross-sectoral training of human resources development in health, environment, and other related sectors and agencies supported by updated materials and guidelines. > Development of inter-country SUMA teams as an expression of Pan Americanism and promotion of SUMA/LSS. > Strengthening of the capacity of local communities and PASB country offices to manage disaster response and integrate a disaster management approach into emerging efforts to combat bioterrorism. > Expanded partnerships at all levels. Proposed Program Budget 2004-2005 31

3.1 Emergency and Humanitarian Action (EHA) EXPECTED RESULTS 1. Strengthening of disaster management systems at the national level. 2. Greater awareness of mitigation issues and increased and capacity to manage this will exist in countries. 3. PASB would have responded effectively and efficiently to disasters. 4. Support for disaster management mobilized internally and externally. INDICATORS Health sector plans at national and subregional levels developed and evaluated. Inter-country cooperation and mutual assistance initiatives increased. Manuals and training materials developed or updated and nationals from related sectors at the national and sub regional levels trained. More publics, such us, government and private sector institutions, professional associations, the media, and beneficiaries aware of disaster mitigation and its link to development. Methodologies for conduct of vulnerability analysis of priority health facilities and water and sanitation systems promoted throughout the Region. Training materials for mitigating the effects of natural hazards on health facilities and water and sanitation systems designed. Nationals from related sectors and staff from PAHO country offices trained in disaster mitigation. Appropriate financial and human resources mobilized and international health assistance at all levels coordinated, in response to disasters within 48 hours. PAHO s post disaster supply management system (SUMA) adapted and adopted by humanitarian agencies at global and regional level and SUMA deployment supported in emergency situations. Emergency health information disseminated to a wide range of publics in a timely manner. Capacity for strengthening disaster management built in PAHO country offices and centers and more components of disaster management integrated into other technical programs. Agreements/projects with a wider range of actors in the disaster community at all levels. 32 Proposed Program Budget 2004-2005

3.1 Emergency and Humanitarian Action (EHA) RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 987,800 11,681,700 12,669,500 Total 2004-2005 1,444,800 1,790,700 3,235,500 Country 100% 100% 100% Percentage of estimated Intercountry - - - expenditure Regional - - - Proposed Program Budget 2004-2005 33

COUNTRY PROGRAM SUPPORT 3.2 STRENGTHENING COUNTRY PRESENCE (CPS) Ensuring continuous country presence and the required organizational infrastructure for the optimal delivery of technical cooperation at the national level. ISSUES AND CHALLENGES > There are 50 countries served by 27 country offices and the border office in El Paso Texas, and the PAHO/WHO country presence needs to complement or supplement the relative capacity already developed by the countries and ensure the principle of equity in the distribution of PAHO/WHO resources, both technical and financial. > The local environment for the execution of TC differs in each case. The efficiency of the execution of the TC programs depends on the administrative support available. Country offices need to be developed to support the technical cooperation demands ensuring the best use of physical, human, and financial resources to effectively and efficiently implement the approved technical cooperation program. > The use of electronic information and communication technology must be expanded to improve the corporate efficiencies as well as to expand the coverage and impact of TC. It will be important to ensure the involvement of the country offices in the broader area of PAHO/WHO institutional development. > Increasing recurrent costs and general operations expenses reduce the funds available for technical work. In addition management has to address the different needs of donors for execution and reporting on EB projects and numerous unplanned demands. > Close collaboration is needed among several offices at Headquarters to provide timely and appropriate support to country offices. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Approved country technical cooperation programs executed effectively and efficiently. AREA OF WORK OBJECTIVE(S) PAHO/WHO country presence is relevant, adequate, and receives the necessary political, technical, administrative and managerial support from all levels of the Secretariat. STRATEGIC APPROACH > Facilitate the appropriate mix of political, technical, and managerial perspectives in the formulation and execution of corporate policies that have implications for country presence. > Engage in analysis, facilitation, negotiation, coordination, and the proposal of recommendations, to ensure optimal country support and PAHO/WHO country presence. 34 Proposed Program Budget 2004-2005

3.2 Strengthening Country Presence (CPS) > Provide institutional memory and act as an information clearinghouse regarding technical issues and administrative procedures. > Develop and share sound and agile administrative mechanisms and procedures to support decentralized technical cooperation and encourage team approach for results-based management. EXPECTED RESULTS 1. Country offices supervised and supported in the design, implementation, and evaluation of the technical cooperation programs. 2. Support to country offices provided and future development planned. INDICATORS Comprehensive and updated country office profile maintained for each country office. Each one of the countries BPBs reviewed for coherence and adequacy to agreed country technical cooperation program and country cooperation strategy and execution monitored. For each country office ensured development plan, orientation to bridge the gap between the current state of the Organization s presence in the country and the desired state in terms of the CCS cooperation strategy and program, plan reviewed annually, and resources mobilized for implementation. For each administrative CO, efficiency and effectiveness of operations, as defined in the management protocol monitored annually. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 18,531,800 1,009,900 19,541,700 Total 2004-2005 19,357,600 540,100 19,897,700 Country 100% 100% 100% Percentage of estimated Intercountry - - - expenditure Regional - - - Proposed Program Budget 2004-2005 35

COUNTRY PROGRAM SUPPORT 3.3 SUPPORT TO NATIONAL HEALTH DEVELOPMENT (NHD) ISSUES AND CHALLENGES > The health development process challenged by: increased inequalities in the health situation; mixed and complex epidemiological profile; transitional stages of health sector reform: unclear roles of different institutions as a result of decentralization; proliferation of actors and stakeholders; reduction of resources; and the impact of integration processes. Country offices have a catalytic role in health systems reform to deliver the essential public health functions. The increased role of civil society and NGOs in the area of health, has implications for the governance and management of the health programs. Negotiations skills and strong advocacy are needed to advance health public policies. > It is essential to increase the knowledge and ownership of the ministries of health about the Organization (PAHO and WHO) in order for them to participate effectively in the governance and normative functions of the Organization. > Country offices must take the lead in helping countries to establish policy coherence, forge cooperative and collaborative mechanisms, and maintain useful partnerships with other UN and bilateral agencies. > The various reforms taking place complicate the planning and execution of technical cooperation: a) The UN reform seeking for closer coordination and integration of all UN agencies country programs; b) the WHO reform seeking to strengthen organizational presence and performance at country level; b) the state and health systems reforms advancing decentralization and recognizing the multiplicity of players including civil society and the private sector. > Country offices must assist countries to integrate the proliferation of planning frameworks and parallel projects competing for human resources UNDAF, CDF, PRSP, CCS, sector-wide approach (SWAP) and to participate in the complex negotiations with financial partners. > Reduced financial resources for technical cooperation: WHO/PAHO budgetary constraints; external cooperation changing focus; IFI s conditions and policies. > Time consuming responsibilities in UNAIDS, UN system groups, questionnaires. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Health positioned at the center of the national development agenda, coordinating national and international efforts for the achievement of the national health objectives. AREA OF WORK OBJECTIVE(S) To assist country offices in leading strategic collaborative efforts to assist the health sector in its steering role and in coordination of international development to optimize the use of TC resources towards the health priorities. 36 Proposed Program Budget 2004-2005

3.3 Support National Health Development (NHD) STRATEGIC APPROACH > Country Cooperation Strategies (CCS) will be developed to define strategic cooperation for PAHO/WHO and linked to AMPES to ensure optimal support for the national health development process. > Support to MOH to play new roles, especially the lead role in coordinating international cooperation. > Negotiate and cultivate support to countries from the global/regional levels and among country offices and centers in order to promote country specificity and sensitivity in responding to country needs and corresponding TC programs. > Advocacy and consensus building among national and international partners for addressing health priorities. EXPECTED RESULTS 1. National capacity to manage and coordinate national and international cooperation to strengthen National Health Development. 2. PAHO/WHO country offices and TC programs to advance the national health agenda supported. 3. Informed and equitable participation by the national authorities in the Governing Bodies. 4. Strategic planning of TC at country level promoted. INDICATORS With particular emphasis on priority countries, the MOHs receive PAHO/WHO support for discharging coordinating role. Advocacy with relevant health development partners at country, sub-regional/regional levels for coordinated support to national priorities and our TC program. Composition of technical groups monitored for geographic representation and Governing Bodies provided with updated history of participation of countries when making relevant decisions. Nationals briefed about plans for, and proceedings of meetings of the Governing Bodies. CCS developed for each one of the priority countries, as well as for other countries where conditions are met for optimal outcome in collaboration with health sector and partners. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 17,430,300 55,900 17,486,200 Total 2004-2005 20,203,500-20,203,500 Country 100% - 100% Percentage of estimated Intercountry - - - expenditure Regional - - - Proposed Program Budget 2004-2005 37

COUNTRY PROGRAM SUPPORT 3.4 TECHNICAL COOPERATION AMONG COUNTRIES (TCC) Promotion and support of activities of technical cooperation among countries within the scope of the different areas of work of the Organization. ISSUES AND CHALLENGES > Many countries have developed capacity for addressing some of the common health problems and are willing to share information and expertise with sister countries. PASB needs to continue to explore innovative and effective ways to nurture these expressions of solidarity in the collective quest for reduced inequities in health. > The subregional integration processes in Central America, the Caribbean, Andean and Southern-Cone regions are opportunities to ensure the full and collective participation in the formulation of health policies within the general development policies. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL In any country, national health development supported by other countries and the advancement of subregional health agendas through the various integration process, and country groupings. AREA OF WORK OBJECTIVE(S) TCC understood and used routinely as one of the technical cooperation modalities for health development. STRATEGIC APPROACH > Continue promoting horizontal cooperation as an expression of Pan Americanism and support country offices to identify opportunities for technical cooperation among countries (TCC). > Strengthen national capacity for TCC, linking health and external affairs interests to (1) address the technical cooperation needs in the countries, and (2) influence and support the integration process. > Support the integration processes and the country offices that serve these institutions. > Promote inter-regional collaboration and participation in WHO global action. EXPECTED RESULTS 1. Initiatives in health in subregional integration processes or among other groups of countries monitored and supported. INDICATORS Technical cooperation provided for the Caribbean Cooperation in Health. Technical cooperation provided as requested for 38 Proposed Program Budget 2004-2005

3.4 Technical Cooperation Among Countries (TCC) MERCOSUR and SGT-11. Technical cooperation provided as requested for Andean health agenda. Technical cooperation provided as requested for Central America health agenda. Technical cooperation for health development provided as requested to groups of countries such as Small Island Developing Countries, Association of Caribbean States, US-México Border, etc. and plans monitored. 2. Technical Cooperation among Countries initiatives supported Development and execution of TCC projects facilitated, monitored, and reported, and selected ones evaluated. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 3,468,400 77,200 3,545,600 Total 2004-2005 3,468,400-3,468,400 Country 100% - 100% Percentage of estimated Intercountry - - - expenditure Regional - - - Proposed Program Budget 2004-2005 39

COUNTRY PROGRAM SUPPORT 3.5 REGIONAL DIRECTOR S DEVELOPMENT PROGRAM (RDP) Supporting innovative technical cooperation initiatives at regional, subregional and country levels that will contribute to the goals of the Organization. ISSUES AND CHALLENGES > Though PAHO has an advanced planning, monitoring, and evaluation system, unforeseen needs arise after the biennial program budget has been approved and during its implementation. > PAHO needs to be a responsive and flexible agency that can address new issues and urgent situations. > New initiatives are developed periodically that are worthy of support before they can be incorporated into the regular program budget process. > Established initiatives may prove to be as effective or productive as to warrant additional support beyond that provided in the approved program budget. > Opportunities for partnerships may arise to address priority needs that require additional resources beyond those available in the regular budget. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Critical and emerging issues in health and development addressed in a timely fashion. AREA OF WORK OBJECTIVE(S) Valuable models and/or opportunities for TC seized and unforeseen needs addressed. STRATEGIC APPROACH > Ongoing monitoring of external environment to alert Directorate to emerging challenges. > Motivate continuous development of new initiatives and increased coverage of programs that have proven to be effective by evaluation and that would yield significantly greater results with additional resources. > Early response to emergency situations that cannot be addressed adequately within planned resources to allow time for mobilization of external resources. > Emphasis will be placed on partnerships with other institutions, especially those that can match the resources provided by the Organization. 40 Proposed Program Budget 2004-2005

3.5 Regional Director s Development Program (RDP) EXPECTED RESULTS 1. Critical projects supported by the Regional Director s Development Program. INDICATORS Member States are satisfied that the RD s funds have been used appropriately for seizing opportunities, responding to emergencies and accelerating use of effective programs. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 1,683,500-1,683,500 Total 2004-2005 1,683,500-1,683,500 Country 100% - 100% Percentage of estimated Intercountry - - - expenditure Regional - - - Proposed Program Budget 2004-2005 41

INTERSECTORAL ACTION AND SUSTAINABLE DEVELOPMENT 4.1 HEALTH AND HUMAN SECURITY (HHS) Fostering intersectoral approaches aimed at reducing the negative impact of social and economic determinants of health and attaining human security. ISSUES AND CHALLENGES > Latin America and the Caribbean is the most inequitable region of the world and in most countries health policies have not addressed the inequities in health and health care related to poverty and ethnicity. > PAHO policies have not properly taken into consideration the reduction of health and health care inequities among their specific objectives. > Globalization, trade, and integration can have positive and negative impacts on health. The health sector must cooperate with other development sectors in order to increase those positive impacts and reduce the negative ones. > The United Nation Millennium Development Goals provide a rich opportunity for promoting the incorporation of health priorities in the regional development agenda. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Member States efforts to reduce health inequities based on evidence and national policy formulation considers trends on health development globally. AREA OF WORK OBJECTIVE(S) Strategic analysis supports corporate policy-making in PAHO and policies related to poverty reduction, ethnicity, globalization and the MDG, mainstreamed in the Secretariat work. STRATEGIC APPROACH > Promoting the use of household surveys data for assessing health inequities at country and regional levels, in collaboration with WHO and the IDB/World Bank/ECLAC MECOVI Initiative. > Promoting and supporting the participation of PAHO and the health sector of its Member States in: the HIPC/PRSP and other poverty reduction initiatives; the follow-up to the UN Durban World Conference Against Racism, Racial Discrimination, Xenophobia, and Related Intolerance; global, regional, and subregional negotiations of trade and integration agreements in collaboration with WTO and WHO. > Advocating the incorporation of health priorities into development agendas at global, regional, and national levels. 42 Proposed Program Budget 2004-2005

4.1 Health and Human Security (HHS) EXPECTED RESULTS 1. Mainstreaming of PAHO corporate policy on health and poverty reduction. 2. Mainstreaming of PAHO corporate policy on ethnicity and health. 3. Mainstreaming of PAHO corporate policy on globalization, trade, integration and health. 4. Mainstreaming of PAHO corporate policy on health and the MDG in the Region. INDICATORS Corporate policy formulated, implemented, and monitored. Impact of corporate policy assessed every year. Corporate policy formulated, implemented, and monitored. Impact of corporate policy assessed every year. Corporate policy formulated, implemented, and monitored. Impact of corporate policy assessed every year. Corporate policy formulated, implemented, and monitored. Impact of corporate policy assessed every year. RESOURCES (US$) Regular budget Other sources All funds Total 2002-2003 7,106,100 966,100 8,072,200 Total 2004-2005 6,021,500 584,600 6,606,100 Country 21% 0% 20% Percentage of estimated Intercountry 79% 100% 80% expenditure Regional - - - Proposed Program Budget 2004-2005 43

INTERSECTORAL ACTION AND SUSTAINABLE DEVELOPMENT 4.2 HEALTHY SPACES AND LOCAL DEVELOPMENT (HSC) Strengthening national capacity to foster public policies and social initiatives for the promotion and development of healthy spaces such as homes, schools, workplaces and municipalities. ISSUES AND CHALLENGES > Although there is abundant evidence that promoting healthy lifestyles and behaviors requires a combination of health promotion strategies, few countries in the Region have integrated health promotion plans of action reflecting this. > Among the strategies for health promotion, advocacy is weak, as is intersectorial coordination and civil society participation in policy and planning. This lack of investment in health promotion presents an obstacle to sustainable social development. > The 2000 Mexico Declaration and PAHO s Directing Council Resolution CD43.R14 adopted in 2001are global and regional commitments among nations that provide a mandate and an opportunity to strengthen countries capacity for the creation of enabling and supportive environments that make healthy choices easy and sustainable. > Latin America has not yet established coherent and integrated local development policies to harmonize the development, health and environment objectives with the need to reduce social inequities. AREA OF WORK GOAL/AREA OF WORK OBJECTIVE(S) AREA OF WORK GOAL Risk to people s health reduced through application of health promotion strategies and establishing wide range of healthy settings created with the participation of stakeholders and with emphasis on needs of special population groups. AREA OF WORK OBJECTIVE(S) Countries better able to design, plan, implement, and evaluate health promotion strategies in support of local development. STRATEGIC APPROACH > Train national and local governments and communities to implement health promotion plans of action, including healthy public policy and healthy settings. > Develop guidelines, models and methodologies to create healthy spaces, including healthy municipalities, communities, worksites and schools that promote and support health, resiliency and protective factors, while preventing and minimizing risks. 44 Proposed Program Budget 2004-2005